In Hoover's test, what does absence of downward pressure from the opposite leg indicate?

• A. Pain on the opposite leg
• B. Patient lack of effort
• C. Increased strength
• D. No response

Answer: (B)

Hoover's test is used to distinguish true leg weakness or organic pain from non-organic symptoms by checking the patient’s effort. The test relies on a subconscious coupling of the legs: when a patient tries to lift the leg on the involved side, the opposite leg should press down into the bed, which the examiner can feel as downward pressure. If this downward pressure from the opposite leg is absent, it suggests the patient is not actually exerting effort and may be presenting non-organic pain or malingering. Conversely, the presence of downward pressure indicates genuine effort and that the reported weakness or pain may be real. So, absence of downward pressure points to lack of effort.